Prognostic factors for gallbladder cancer in Japan.
OBJECTIVE
The objective of this study was to evaluate prognostic predictors for patients with gallbladder cancer (GBC) in a Japanese nationwide data base.


BACKGROUND
GBC is the most common cancer of the biliary tract in Japan. Differences in the survival rates between Japan and other countries have been noted.


METHODS
The authors analyzed 4424 patients with GBC in Japan between 1988 and 1997. Staging was determined in accordance with American Joint Committee on Cancer stage.


RESULTS
Survival is related closely to the surgical stage. Five-year survival rates for stage I, II, III, IVA, and IVB (5th edition) were 83%, 70%, 45%, 23%, and 9%, respectively. These differences were significant (P < 0.0001). The survival rate for patients aged <60 years was significantly better (P < 0.05). The survival rate for patients aged >69 years was significantly worse (P < 0.01). The cholecystectomy plus combined resection of bile duct and/or liver bed resection had an effect on prolonging the survival in stage II or III disease, but extended resection did not. The patients with anomalous pancreaticobiliary ductal junction had a survival advantage over those with cholelithiasis by univariate analysis. However, multivariate analyses indicated that only age, sex, stage, operative procedures were independent prognostic factors. Stage was the strongest covariate; patients diagnosed with stage II, III, IVA, or IVB disease were 2.2, 4.2, 8.1, and 13.6 times, respectively, were more likely to die.


CONCLUSIONS
Staging is the strongest prognostic factor for GBC, but patient outcomes were also affected by age, sex, and operative procedures. The data do not support any advantage for extended resection. Neither gallstones nor anomalous pancreaticobiliary ductal junction influenced the GBC patient outcome.
Kayahara
Masato
M
Department of Gastroenterological Surgery, Division of Cancer Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan. masatok@surg2.m.kanazawa-u.ac.jp
Nagakawa
Takukazu
T
Nakagawara
Hisatoshi
H
Kitagawa
Hirohisa
H
Ohta
Tetsuo
T
D000368:Aged; D017734:Bile Ducts, Extrahepatic / Q000002:abnormalities; D002769:Cholelithiasis / Q000453:epidemiology; D013505:Digestive System Surgical Procedures; D005260:Female; D005706:Gallbladder Neoplasms / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010183:Pancreatic Ducts / Q000002:abnormalities; D011379:Prognosis; D016016:Proportional Hazards Models; D016019:Survival Analysis